MENTEE APPLICATION FORM

First Name *

Last Name *

Phone *

Email *

Date of birth

City

State

Educational Background: (e.g., high school student, nursing student, recent graduate, working RN)

Current School or Program (if applicable):

Expected Graduation Date:

Why are you interested in having a nursing mentor?

Tell us what you hope to learn or achieve through this mentorship?

If "Other" Please type here

What kind of support are you looking for from a mentor? (e.g., advice on clinicals, balancing school and work, career paths, NCLEX study tips)

Preferred Meeting Style:

In-Person

Virtual

Either

Availability (days/times):

Is there anything else you’d like us to know to help us match you with the right mentor?

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